Prosthetic Orthotic Center Forms

Click Buttons Below To Download Forms Pre-registration FormPatient Survey Form

We here at POC take great pride in our services. our goal is to restore your mobility and confidence in a way that will meet or exceed your highest expectations. Your quality of life is our concern.

Before your first appointment we recommend that you download, print, and complete the Pre-Registration/Medical History Form below and bring it with you to your appointment.

We also suggest that you review the following HIPAA notice. This notice provides you with information regarding how your personal health information may be used by staff at POC or disclosed to other care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. Your health information may also be used to seek payment from your health plan or from other sources that we may use to pay for services.

The best health care is based on a friendly and mutual understanding between staff, practitioner and patient. After your visit to POC please complete our patient survey so that we can find out how to better serve you and meet your needs. Once you have downloaded, printed, and completed the survey, we ask that you mail it to:

Prosthetic Orthotic Center
c/o Bob Lotz
935 S. 17th Ave.
Wausau, WI 54401
Or, you may fax it to 715-845-6310.

Quality Of Life is Our Concern